Screening for proximal coronary artery anomalies with 3-dimensional MR coronary angiography

Area of Science:

• Cardiovascular Imaging
• Sports Cardiology
• Medical Diagnostics

Background:

• Coronary artery anomalies (CAA) cause a significant portion of sudden cardiac death in athletes under 35.
• Screening for CAA is crucial for preventing adverse cardiac events in athletic populations.
• Standard cardiac MRI protocols may not adequately detect proximal coronary artery variations.

Purpose of the Study:

• To evaluate the feasibility and effectiveness of free-breathing 3-dimensional magnetic resonance coronary angiography (3D-MRCA) for screening coronary artery anomalies (CAA).
• To assess the diagnostic performance of 3D-MRCA as an adjunct to standard cardiac MRI in athletes and non-athletes.
• To determine image quality differences between athletes and non-athletes using 3D-MRCA.

Main Methods:

• 360 healthy participants (207 athletes, 153 non-athletes) aged 18-60 years underwent standard cardiac MRI with an additional 10-minute 3D-MRCA.
• The 3D-MRCA scans were screened for various types of coronary artery anomalies.
• Coronary CT-angiography (CTA) was used for confirmatory imaging in subjects with identified anomalies or stenosis.

Main Results:

• A technically satisfactory 3D-MRCA was obtained in 93% of subjects.
• Four participants (1%) exhibited a malignant variant of the right coronary artery (RCA) origin.
• Additional findings included RCA kinking/stenosis and myocardial bridging; 3D-MRCA quality was superior in athletes due to lower heart rates.

Conclusions:

• Free-breathing 3D-MRCA is a viable tool for screening proximal coronary artery anomalies in both athletes and non-athletes.
• Integrating 3D-MRCA into standard cardiac MRI protocols can enhance the detection of potentially life-threatening coronary artery variations.
• The technique shows promise for improving cardiovascular safety assessments in young, competitive athletes.